The Freestyle Aortic Bioprosthesis: A Systematic Review

Sherrah, Andrew G.; Vallely, Michael P.

doi:10.1016/j.hlc.2013.10.068

Cited by 4 publications

(4 citation statements)

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“…The observed pooled early mortality was 5.5%. This is in accordance with an older review on aortic root replacement (4.5 to 5.3%) and with the recent report of the Society of Thoracic Surgeons database from the U.S. that estimates early mortality after bioprosthetic aortic root replacement to be 6.2% (45,46). However, these studies include also acute and emergent operative indication like endocarditis and aortic dissection.…”

Section: Early Mortalitysupporting

confidence: 91%

Clinical outcome after bioprosthetic aortic root replacement: A Meta-Analysis and Microsimulation model

Arabkhani

2021

Preprint

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Background and aim of the study This study aims to provide an overview of clinical outcome after bioprosthetic aortic root replacement and lifetime event-risk estimates of mortality and valve-related events, and the potential effect of type of prosthesis used. Methods A systematic literature search was conducted between January 2000 and August 2019. Inclusion criteria: aortic root replacement in adults. Data were pooled by inverse-variance weighting and entered a microsimulation model to calculate lifetime event-risk and (event-free) life expectancy. Results Of 2,106 publications, 31 were included (N = 5,227 patients, 74% stentless valves). Mean age was 65.4 years (74% male). Pooled early mortality was 5.5% (95% CI: 4.3-7.2%). During follow-up (mean 4.1 years, total 22.706 patient-years), late mortality was 4.8%/patient-year and reoperation 0.9%/patient-year. Linearized-occurrence-rates for thromboembolism, endocarditis, and hemorrhagic events:1.2; 0.9 and 0.5 %/patient-year; no significant difference between stented and stentless prosthesis. Translating into a 60-year-old patient, an estimated life expectancy of 14 years (general population: 22 years) and lifetime risks of thromboembolism, endocarditis and reintervention of 21%, 13%, and 8%, respectively is expected. Conclusions The study shows impaired survival and a notable lifetime risk of valve-related events after bioprosthetic aortic root replacement. The risk of thromboembolism is prominent, especially during earlier follow-up, suggesting higher risk of thromboembolism early after operation. Type of prosthesis, stented or stentless, is not associated with higher valve-related events. Moreover, this study could be used as a benchmark to compare outcome with other aortic root replacement procedures.

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Section: Early Mortalitysupporting

confidence: 91%

Clinical outcome after bioprosthetic aortic root replacement: A Meta-Analysis and Microsimulation model

Arabkhani

2021

Preprint

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“…No matter which stentless technique (inclusion/modified inclusion or total root replacement) is used, there are additional suture lines required and coronary artery reimplantation. Our operative mortality rate (3.3%) appears to be comparable with other studies in the literature, which include 300 or more cases whose mortality rate ranges from 3.4% to 8% 7,[10][11][12] ; however our study did not include patients with endocarditis. The incidence of complete heart block requiring pacemaker in our study was 4%, which was half of the reported incidence.…”

Section: Commentsupporting

confidence: 84%

Influence of Age on Longevity of a Stentless Aortic Valve

Yang

Malik

Farhat

et al. 2020

The Annals of Thoracic Surgery

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Background. The longevity of a stentless valve in a younger population (20-60 years old) is unknown.Methods. From 1992 to 2015, 1947 patients underwent aortic valve/root replacement for aortic stenosis, insufficiency, root aneurysm, or aortic dissection with stentless bioprostheses (median size, 26 mm). At operation 105 patients were <40 years old, 528 were 40 to 59, 860 were 60 to 74, and 454 were ‡75 years. The data were obtained through chart review, administered surveys, and the National Death Index.Results. The 30-day mortality rate was 2.6%. During follow-up 807 patients (41%) died before reoperation, 993 (51%) were alive without reoperations because of deterioration, and 113 patients (5.8%) underwent reoperation for structural valve deterioration. After adjusting death and reoperation for non-structural valve deterioration causes as competing risks, the cumulative incidence of reoperation was significantly different between the younger groups (<40, 40-59) and the older groups (60-74, ‡75; P < .0001) but not inside the younger (<40 vs 40-59) or older (60-74 vs ‡75) group. The significant hazard ratio of reoperation for <40 versus ‡75 years of age was 12, <40 versus 60 to 74 was 4, 40 to 59 versus 60 to 74 was 3, and 40 to 59 versus ‡75 was 9 (P £ .01). The 10-and 15-year survival in the entire cohort was 53% and 29%, respectively.Conclusions. The stentless aortic valve provides satisfactory durability as a conduit for aortic valve/root replacement for patients who prefer a bioprosthesis. However it should be judiciously considered for patients younger than 60 years because of an increased incidence of reoperation for structural valve deterioration.

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“…Furthermore, this study population accounts for an inhospital mortality of 18.6%, which is elavated when compared to isolated AVR with Freestyle prosthesis. Indeed, in their systematic review Sherrah et al, reported an in-hospital mortality of 5.2% after Freestyle implantation (10). When our results are placed into perspective, and consideration is made of mortality rates in combined aortic root procedures, high-risk patients, reoperations, or freestyle prosthesis implantation in destructive endocarditis, the outcomes could be considered comparable (11)(12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 72%

Geometric Changes in Aortic Root Replacement Using Freestyle Prosthesis

Oßwald

Rad

Vardanyan

et al. 2021

Preprint

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Background: The Medtronic freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation.Methods: Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n=32) and postoperative (n=10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified. Results: Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p<0.001). Bicuspid valve was present in 28.1% of the patients. Diameter and areas of the aortic root decreased after freestyle implantation, resulting in a reduction of the aortic root volume (45.6 ± 26.3 cm3 to 18.7 ± 4.5 cm3, p=0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p=0.023). Conclusion: Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Pre-operative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.

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The Freestyle Aortic Bioprosthesis: A Systematic Review

Cited by 4 publications

References 0 publications

Clinical outcome after bioprosthetic aortic root replacement: A Meta-Analysis and Microsimulation model

Clinical outcome after bioprosthetic aortic root replacement: A Meta-Analysis and Microsimulation model

Influence of Age on Longevity of a Stentless Aortic Valve

Geometric Changes in Aortic Root Replacement Using Freestyle Prosthesis

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